Health-Related Outcomes among the Poor: Medicaid Expansion vs. Non-Expansion States.
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ABSTRACT: Introduction
States' decisions not to expand Medicaid under the Affordable Care Act (ACA) could potentially affect access to care and health status among their low-income residents.Methods
The 2010-2012 nationally representative Medical Expenditure Panel Survey data were analyzed in 2015 to compare 9755 low-income adults aged 18-64 years from Medicaid-expanding states with 7455 adults from nonexpanding states. Multivariate logistic regression models were fitted to evaluate the differences in access to care, receipt of preventive services, quality of care, attitudes about health and self-reported health status by Medicaid expansion status. The differences in care utilization and medical expenditures between the two groups were examined using a 2-part modeling approach.Results
Compared to their counterparts in Medicaid expansion states, low income adults in the nonexpanding states were more likely to be black and reside in rural areas and were less likely to have a usual source of care (prevalence ratio[PR] 0.86, 95% confidence interval[CI] 0.82-0.91) and recommended preventive services such as dental checkups (PR = 0.86; CI = 0.79-0.94), routine checks (PR = 0.89; CI = 0.83-0.95), flu vaccinations (PR = 0.89; CI = 0.81-0.98), and blood pressure checks (PR = 0.96; CI = 0.94-0.99). They also had less care utilization, fewer prescriptions, and less medical expenditures, but more out-of-pocket expenditures (all p-value <0.05).Conclusions
Low-income adults in Medicaid nonexpanding states, who are disproportionately represented by blacks and rural residents, were worse off for multiple health-related outcomes compared to their counterparts in Medicaid expanding states at the baseline of ACA implementation, suggesting that low income adults residing in nonexpanding states may benefit markedly from the expansion of Medicaid.
SUBMITTER: Han X
PROVIDER: S-EPMC4700996 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Of the fourteen states that have not expanded eligibility for Medicaid, nine are in the southern census region, and two others border that region. Ongoing debate over the merits of Medicaid expansion in these states has focused, in part, on whether the safety net provides sufficient access for uninsured low-income Americans. We analyzed longitudinal survey and vital status data from the twelve-state Southern Community Cohort Study (SCCS) for 15,356 nonelderly adult participants with low incomes, 86 percent of whom were enrolled at community health centers. In difference-in-differences analyses, we compared changes in self-reported health between participants in four expansion and eight nonexpansion states before (2008-13) and after (2015-17) Medicaid expansion. We found that a higher proportion of SCCS participants in expansion states reported increases in Medicaid coverage (a differential change of 7.6 percentage points), a lower proportion experienced a health status decline (-1.8 percentage points), and a higher proportion maintained their baseline health status (1.4 percentage points). The magnitude of estimated reductions in health declines would meaningfully affect a nonexpansion state's health ranking in our sample if that state elected to expand Medicaid. Our results suggest that for low-income adults in the South, Medicaid expansion yielded health benefits-even for those with established access to safety-net care.
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Project description:ObjectiveThis study aimed to evaluate associations of Medicaid expansion with health care access for adults with obesity and to explore racial/ethnic differences in these changes in health care access.MethodsUsing 2011 to 2017 Behavioral Risk Factor Surveillance System data, the study compared health care access measures among adults who were aged ≥18 years and who had BMI ≥ 30 kg/m2 and household income ≤ 138% of the federal poverty line by state Medicaid expansion status using a difference-in-differences approach with logistic regression. The authors further stratified the main analysis by race/ethnicity.ResultsMedicaid expansion was associated with improvements in health care access, including lower proportions of those without a usual source of care (-3.6%, 95% confidence interval [CI]: -5.8% to -1.4%, p < 0.01) and cost as a barrier to medical care (-4.5%, 95% CI: -7.0% to -1.9%, p < 0.01). No significant changes were found in routine medical checkups in the last year (-1.8%, 95% CI: -4.4% to 0.8%, p = 0.12). However, across these measures, Medicaid expansion was consistently associated with better access among non-Hispanic White adults (-6.0% to -7.9%, p < 0.01) and not at all among non-Hispanic Black and Hispanic adults (p > 0.05).ConclusionsMedicaid expansion was associated with significant improvements in health care access among adults with obesity, but these improvements were variable across race and ethnicity.
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Project description:OBJECTIVE:To assess the effect of the 2014 Medicaid expansion on Medicaid managed care plan quality. DATA SOURCES:Three composite measures of plan-level quality constructed from the Health Care Effectiveness Data and Information Set. STUDY SETTING:One hundred and sixty-three plans in 27 Medicaid expansion states and 100 plans in 14 nonexpansion states. STUDY DESIGN:Quasi-experimental difference-in-differences (DID) analysis, comparing quality before (2011-13) and after (2014-15) Medicaid expansion in states that elected to expand Medicaid eligibility and those that did not. PRINCIPAL FINDINGS:Mean plan enrollment increased from 130,533 to 274,259 in expansion states and from 105,449 to 148,194 in nonexpansion states. The proportion of enrollees receiving recommended preventive care increased from 62.6 to 65.2 percent in expansion states and from 59.3 to 62.5 percent in nonexpansion states (adjusted DID: -0.7 percentage points [95% CI -2.2, 0.7]). The proportion of enrollees receiving recommended chronic disease care management increased from 65.4 to 66.0 percent in expansion states and from 62.5 to 63.1 percent in nonexpansion states (adjusted DID: 1.1 percentage points [95% CI -0.5, 2.6]). We observed similar patterns for the receipt of recommended maternity care. CONCLUSIONS:Medicaid expansion increased enrollment in managed care plans, but it did not result in erosion of quality.
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